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Introduction: Suicide is a leading cause of death worldwide and models may help the understanding of the phenomenon and ultimately reduce its burden through effective suicide prevention strategies. The Interpersonal Theory of Suicide and Shneidman's Model have tried to describe different unmet needs related to suicidal ideation. The study aims to assess the association between thwarted belongingness, perceived burdensomeness, and suicidal ideation in a sample of psychiatric inpatients and the mediating role of hopelessness and mental pain in this association., Methods: 112 consecutive adult psychiatric inpatients were administered the Columbia Suicide Severity Rating Scale (C-SSRS), the Italian version of the Interpersonal Needs Questionnaire-15-I (INQ-15-I), the Physical and Psychological Pain Scale, and the Beck Hopelessness Scale (BHS)., Results: Mediation models indicated a significant indirect effect of perceived burdensomeness (with thwarted belongingness as covariates) on suicidal ideation intensity with hopelessness as a mediator. When thwarted belongingness (controlling for perceived burdensomeness as a covariate) was included in a model as an independent variable, direct and indirect effects on suicidal ideation intensity were not significant., Conclusions: Psychosocial interventions focusing on identifying and decreasing the perception of being a burden for others and the feeling hopeless could represent a powerful pathway for reducing suicidal ideation. Moreover, the attention toward unmet interpersonal needs may help increase and focus clinical discussions on risk factors, which may help engagement toward psychiatric care and downsize the stigma related to suicide. Raising awareness toward mental health topics is a goal of healthcare services globally., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Introduction: Several features contribute to determining suicide risk. This study was designed with the aim of evaluating whether insight into illness and demoralization are involved in suicide risk (active suicidal ideation or behavior)., Methods: For this purpose, in a sample of 100 adult psychiatric inpatients, we used the Columbia Suicide Severity Rating Scale to assess suicide risk, the Demoralization Scale for demoralization symptoms, and the Insight Scale to assess illness insight. We also investigated several demographic and clinical features, including gender, age, duration of untreated illness, previous suicide attempts, and nonsuicidal self-injurious behavior., Results: The results demonstrated that patients with higher scores on the insight-high dimension had 1.35 greater odds of having a higher suicide risk, and those with lifetime suicide attempts had 7.45 greater odds of having a higher suicide risk. Among the various clinical factors, the study indicated that only nonsuicidal self-harm behaviors in the last 3 months was a risk factor for suicide risk., Conclusions: The results indicated that greater illness insight is involved in suicide risk regardless of demoralization., (© 2021 S. Karger AG, Basel.)

Objective: The aim of this multicenter study was to investigate the differences in personality traits, particularly Neuroticism, in three clinical samples and three student samples in Austria and Italy and their impact on suicide., Methods: In total, 1,043 people (410 psychiatric inpatients and 633 university students) were tested in three regions of Europe: central Italy, northeast Italy, and eastern Austria. Psychiatric diagnoses were evaluated using the Mini-International Neuropsychiatric Interview, and the following instruments were used: Sociodemographic Questionnaire, Columbia-Suicide Severity Rating Scale-B, Symptom-Checklist-90-Standard, and Big Five Inventory., Results: The study found that the intensity of Suicidal Ideation was associated with the personality traits of Neuroticism, Anxiety, and Extraversion but also with Depression., Conclusions: In conclusion, without the presence of Depression symptoms, neuroticism was a protective factor against Suicidal Ideation, whereas neuroticism when comorbid with Depression symptoms increased suicide risk in psychiatric patients. In all three regions, the clinical samples had higher scores for Neuroticism and for Depression symptoms than the student sample and consequently higher scores for Suicide. Furthermore, we demonstrated an interaction between gender and culture on personality traits, supporting the hypothesis that the distribution of self-reported personality traits is organized geographically., (© 2019 The American Association of Suicidology.)

Psychological pain is a core clinical factor for understanding suicide, independently from depression. The aim of this study is to assess the role of psychological pain on suicide risk and to evaluate the relationship between psychache and different psychiatric disorders. We conducted the present cross-sectional study on 291 inpatients with a diagnosis of major depressive disorder, bipolar disorder, and schizophrenia. We administered Shneidman's Psychological Pain Assessment Scale (PPAS) for the assessment of mental pain and the Mini International Neuropsychiatric Interview (MINI) for the assessment of suicide risk. There was a significant association between current psychache and worst-ever psychache and suicide risk in inpatients affected by a depressive disorder, bipolar disorder and schizophrenia. Furthermore, we found a significant difference in current psychache between inpatients with major depressive disorder and inpatients with schizophrenia and in worst-ever psychache between inpatients with bipolar disorder and inpatients with schizophrenia, with lower scores in inpatients with schizophrenia. The assessment of psychache appears to be useful for predicting suicidal risk and should be used routinely for identifying and treating suicide risk in clinical practice.

Background Demoralization has been defined by hopelessness and helplessness attributable to a loss of purpose and meaning in life. Demoralization is a meaningful mental health concern, frequently associated with suicide risk in medical and psychiatric patients. The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with schizophrenia and to better understand the relationship between demoralization and suicide risk in patients with schizophrenia. and Objectives The findings suggested that demoralization is prevalent in patients with schizophrenia and supported the hypothesis that the association between depression and suicide is moderated by hopelessness. In clinical practice, it is important to recognize symptoms of demoralization using appropriate psychological tools to better understand the suffering of patients with schizophrenia and to implement suicide prevention programs.: Demoralization has been defined by hopelessness and helplessness attributable to a loss of purpose and meaning in life. Demoralization is a meaningful mental health concern, frequently associated with suicide risk in medical and psychiatric patients. The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with schizophrenia and to better understand the relationship between demoralization and suicide risk in patients with schizophrenia. Methods: A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with several bibliographic databases, resulting in the identification of 27 studies. Results: The findings suggested that demoralization is prevalent in patients with schizophrenia and supported the hypothesis that the association between depression and suicide is moderated by hopelessness. In clinical practice, it is important to recognize symptoms of demoralization using appropriate psychological tools to better understand the suffering of patients with schizophrenia and to implement suicide prevention programs., Competing Interests: The authors declare no conflict of interest

Introduction: Although several authors have investigated the relationship between demoralization, insight, and suicide risk, the role of these factors in determining suicide risk in patients with psychiatric disorders is still unclear [Berardelli et al., 2019; Costanza et al., 2020]. Objectives: The main aim of this study was therefore to determine whether suicide risk was associated with better insight and worse demoralization in a sample of 100 adult psychiatric inpatients. Methods: The study was performed on 100 psychiatric hospitalized adult patients consecutively enrolled between January 2019 and April 2020 at psychiatric units of Sant'Andrea Medical Center, Sapienza University of Rome. The Columbia Suicide Severity Rating Scale (C-SSRS) was used to assess suicide risk, Demoralization was assessed using the Demoralization Scale (DS) [Kissane et al., 2004] and for the assessment of insight we used the The Insight Scale (IS). Results: Only age was significantly associated with higher suicide risk (χ²=9.07, p<0.01). The variable mood disorder was significantly associated with higher suicide risk (χ22=7.50, p<0.05). Non-suicidal self-harm behaviors in the last 3 months (χ²=5.89, p<0.05) and lifetime suicide attempts (χ²=21.80, p<0.001) were significantly associated with higher suicide risk. Only the insight-high dimension (χ²=8.01, p<0.01) and lifetime suicide attempts (χ²=12.33, p<0.001) were significantly associated with higher suicide risk. Conclusions: Our results don't confirm the role of demoralization in suicide risk. In our sample of patients, only high insigth of illness and other psychological variables are involved in suicide risk. [ABSTRACT FROM AUTHOR]

Introduction: A history of suicide attempts represents the strongest predictor of completed suicide. Studies suggested that multiple suicide attempters (MSAs) might present a higher risk of suicide than those who attempted once (SSAs). To date, only a few studies examined the characteristics of MSAs compared to SSAs. Objectives: To assess the socio-demographic and clinical characteristics of SSAs, MSAs, and suicidal ideators (SIs) and compare the risk of reattempt. We hypothesized that MSAs might be at higher risk of reattempt compared to the other groups. Methods: The study sample consisted of 153 adult inpatients admitted to the emergency psychiatric unit at Sant'Andrea Hospital in Rome. Patients with suicidal ideation or attempted suicide were included. We divided them into three groups using the Columbia Suicide Severity Rating Scale (58 SSAs, 65 MSAs, 30 SIs). Sociodemographic and clinical features were collected through interviews and the Beck Hopelessness Scale (BHS). Continuous variables were compared using Student's t-test and Kruskal Wallis test, categorical variables through X2-test. Results: The components "future expectations" and "loss of motivation" at the BHS were significantly higher in SAs than in SIs (p=0,021; 0,006). MSAs, compared to SSAs, presented more lethal than suicide attempts (2.3±0.9 vs. 1.5±1.1, p<0.001). Conclusions: According to our preliminary findings, having attempted suicide is associated with lower hope and motivation towards the future and increased lethality of the subsequent attempts. Our results confirmed that MSAs are at higher risk of reattempting suicide using a more lethal method than SSAs. [ABSTRACT FROM AUTHOR]